Provider Demographics
NPI:1104037357
Name:LANE, ISABELLE ESCANO (DO)
Entity Type:Individual
Prefix:MRS
First Name:ISABELLE
Middle Name:ESCANO
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:330-626-5566
Mailing Address - Fax:330-626-2042
Practice Address - Street 1:9480 ROSEMONT DR STE 100
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4569
Practice Address - Country:US
Practice Address - Phone:330-626-5566
Practice Address - Fax:330-626-2042
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.001901207Q00000X
OH34-009525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2990232Medicaid
OH2990232Medicaid